Are antibiotics indicated for an impacted wisdom tooth?

Antibiotics for Impacted Wisdom Teeth

Antibiotics are NOT routinely indicated for asymptomatic impacted wisdom teeth, but prophylactic antibiotics should be considered when surgical extraction is planned, as they reduce infection risk by approximately 70% in healthy patients undergoing third molar surgery. 1, 2

When Antibiotics Are NOT Indicated

• Asymptomatic impacted wisdom teeth without signs of infection do not require antibiotics 1
• Simple impaction without systemic symptoms (fever, lymphadenopathy, cellulitis) or spreading infection should be managed with surgical intervention alone 1
• The primary treatment for impacted wisdom teeth is mechanical/surgical removal, not antimicrobial therapy 3

When Antibiotics ARE Indicated

For Surgical Extraction (Prophylactic Use)

Prophylactic antibiotics reduce postoperative complications in patients undergoing third molar extraction: 2

• Infection risk reduction: 70% (12 patients need treatment to prevent one infection) 2
• Dry socket reduction: 38% (38 patients need treatment to prevent one case) 2
• Pain reduction at 7 days post-extraction (mean difference -8.17 points) 2

For Active Infection

Antibiotics are indicated when impacted wisdom teeth present with: 1

• Acute dentoalveolar abscess with systemic involvement 1
• Fever, lymphadenopathy, or cellulitis 1
• Diffuse swelling extending into cervicofacial tissues 1
• Progressive infection requiring specialist referral 1, 3

Recommended Antibiotic Regimens

First-Line Choice

Amoxicillin is the preferred antibiotic: 1, 4

• Prophylactic dosing for extraction: 250 mg every 8 hours × 3 doses beginning 1 hour before surgery 4
• For active infection: Standard therapeutic dosing for 5 days 1
• This regimen shows sufficient efficacy in preventing surgical site infections in patients without risk factors 4

Second-Line Choice

Amoxicillin-clavulanic acid for treatment failures or higher-risk scenarios 1, 5

Alternative Consideration

Phenoxymethylpenicillin is an acceptable alternative first-choice agent 1

Important Clinical Caveats

Risk-Benefit Considerations

• Adverse effects occur in 1 in 21 patients receiving prophylactic antibiotics (generally mild and transient) 2
• The number needed to treat (12 patients) to prevent one infection must be weighed against antimicrobial resistance concerns 2
• All evidence comes from healthy patients undergoing third molar extraction—generalizability to immunocompromised patients or those with severe periodontal disease is unclear 2

What Antibiotics Do NOT Improve

Prophylactic antibiotics show no significant benefit for: 2

• Fever at 7 days post-extraction
• Swelling at 7 days post-extraction
• Trismus (limited mouth opening) at 7 days post-extraction

Geographic Variation Alert

Antibiotic prescribing for wisdom tooth surgery varies dramatically by region (18.6% to 48% prescription rates), suggesting lack of standardized practice 6

Non-Antibiotic Management When Surgery Is Delayed

If extraction must be delayed and the tooth is symptomatic but without systemic infection: 3

• Chlorhexidine mouthwash (0.12-0.2%) has proven efficacy for controlling local inflammation 3
• Natural product-based mouthwashes (turmeric 0.1%, lemongrass oil 0.25%) show comparable efficacy to chlorhexidine 3
• Optimize oral hygiene with proper brushing and interdental cleaning 3

Key Pitfall to Avoid

Do not prescribe antibiotics for uncomplicated impacted wisdom teeth without planned extraction or signs of active infection—this represents inappropriate antimicrobial use that contributes to resistance without clinical benefit. 1, 3 Surgical source control through extraction remains the definitive treatment. 1